3 ms·

> He was all too familiar with that precarious balance. In 2008, he had tried to commit suicide by taking enough codeine to kill two people, but he'd woken up t

> He was all too familiar with that precarious balance. In 2008, he had tried to commit suicide by taking enough codeine to kill two people, but he'd woken up the next morning with only a headache—his body had absorbed it all. I am nearly speechless. Suicide is no joke, but assuming the story here is true, it's kind of remarkable that a person's morbid obesity saved them from death in such an ironic way. If he was at a lower end of obesity he might not be alive today. Does anyone here have background knowledge to know whether this story is plausible? I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it.

stordoff 5y ago
I'm not overly familiar with the mechanics of codeine in overdose, but the toxicity of paracetamol (acetaminophen) can be estimated based on the mg/kg ingested, albeit with a cap at 110kg: > To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).[1] It strikes me as at least plausible that codeine could be behave in a similar way. [1] https://bnf.nice.org.uk/treatment-summary/poisoning-emergency-treatment.html https://bnf.nice.org.uk/treatment-summary/poisoning-emergenc...
sbierwagen 5y ago
Drugs for children are dosed in mg per kg, with calculators to suit: https://reference.medscape.com/calculator/650/weight-based-medication-dosing https://reference.medscape.com/calculator/650/weight-based-m... Adults are usually about the same size, so it's less of a problem there. Usually. https://www.nytimes.com/2018/06/08/well/drug-dose-weight-size-doctors-prescriptions-medications.html https://www.nytimes.com/2018/06/08/well/drug-dose-weight-siz...
- Broken_Hippo 5y ago
  Drugs for children aren't only dosed per kg: Sometimes children have different bodily functions than adults [1]. Children might not clear out medicines like adults, for example, and it means they need a lower per KG dose. This is also a concern when giving children vaccines, though it is more due to the way a child's immune system operates differently than an adult's. [1] https://www.msdmanuals.com/professional/pediatrics/principles-of-drug-treatment-in-children/pharmacokinetics-in-children#:~:text=Drug%20metabolism%20and%20elimination%20vary,in%20neonates%20than%20in%20adults https://www.msdmanuals.com/professional/pediatrics/principle....
jamil7 5y ago
> I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth I thought it was the opposite. The effect of medication, drugs and alcohol all seem to depend at least partly on body mass.
c22 5y ago
Codeine isn't designed or intended to kill you, so I'm not sure we can say anything about the effectiveness of the medication in this case.
Broken_Hippo 5y ago
"I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it." It definitely affects it: This is part of the reason they ask you for your weight before you get an MRI with contrast (The amount of contrast changes on your weight) and IIRC, they change the dose of IV morphine depending on your weight. Realistically, this is also the case for some drugs - a small person generally gets drunk faster than a large one. But it doesn't matter as much for some drugs than others: Two adults can generally take the same amount of ibuprofen because the differences aren't really all that large. Extremes are going to change this, though.

stordoff 5y ago

I'm not overly familiar with the mechanics of codeine in overdose, but the toxicity of paracetamol (acetaminophen) can be estimated based on the mg/kg ingested, albeit with a cap at 110kg: > To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110 kg, use a body-weight of 110 kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg).[1] It strikes me as at least plausible that codeine could be behave in a similar way. [1] https://bnf.nice.org.uk/treatment-summary/poisoning-emergency-treatment.html https://bnf.nice.org.uk/treatment-summary/poisoning-emergenc...

sbierwagen 5y ago

Drugs for children are dosed in mg per kg, with calculators to suit: https://reference.medscape.com/calculator/650/weight-based-medication-dosing https://reference.medscape.com/calculator/650/weight-based-m... Adults are usually about the same size, so it's less of a problem there. Usually. https://www.nytimes.com/2018/06/08/well/drug-dose-weight-size-doctors-prescriptions-medications.html https://www.nytimes.com/2018/06/08/well/drug-dose-weight-siz...

Broken_Hippo 5y ago
Drugs for children aren't only dosed per kg: Sometimes children have different bodily functions than adults [1]. Children might not clear out medicines like adults, for example, and it means they need a lower per KG dose. This is also a concern when giving children vaccines, though it is more due to the way a child's immune system operates differently than an adult's. [1] https://www.msdmanuals.com/professional/pediatrics/principles-of-drug-treatment-in-children/pharmacokinetics-in-children#:~:text=Drug%20metabolism%20and%20elimination%20vary,in%20neonates%20than%20in%20adults https://www.msdmanuals.com/professional/pediatrics/principle....

jamil7 5y ago

> I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth I thought it was the opposite. The effect of medication, drugs and alcohol all seem to depend at least partly on body mass.

c22 5y ago

Codeine isn't designed or intended to kill you, so I'm not sure we can say anything about the effectiveness of the medication in this case.

Broken_Hippo 5y ago

"I could swear I've heard that the thing about body mass affecting the effectiveness of medication was a myth, but I'm not sure where I heard it." It definitely affects it: This is part of the reason they ask you for your weight before you get an MRI with contrast (The amount of contrast changes on your weight) and IIRC, they change the dose of IV morphine depending on your weight. Realistically, this is also the case for some drugs - a small person generally gets drunk faster than a large one. But it doesn't matter as much for some drugs than others: Two adults can generally take the same amount of ibuprofen because the differences aren't really all that large. Extremes are going to change this, though.